MD/DO vs Mid-level Salary

[Yadster101]

So my question concerns the salary difference between MD/DOs and mid-levels that each do 99% the same job. I don't want to argue if PAs/NPs should be able to do the same job as some FM, IM, Psych, and sometimes even EM physicians. I think I'd prefer if they were not able to do the same work, but the fact is that there are many facilities where PAs/NPs and MDs/DOs literally just split patients and do the exact same work.

So why is it that physicians at these places still make ~2X the mid-level salary? Is it simply because of liability? I know that in many states, NPs can practice independently, yet they still make ~1/2 the salary...so I don't think it's just liability. Do you think in the future mid-level salaries will rise and physician salaries will fall? I refuse to believe that hospital admins are paying docs more, for the same work, simply out of the kindness of their hearts.

Disclaimer: I agree that physicians have wayyy more training. Still the fact is that there are MANY places where an FM doc and PA just split the pts.

Edit: I was really hoping this wouldn't become an argument about whether or not this is an issue. My research was coming from personal experiences in the hospital and from some older threads w/ attending like @Perrotfish . His exact quote was, "You are definitely right that, in many clinics and hospitals I have rotated through, midlevels are allowed the same scope of practice as a physician."

I'm not saying that this happens in the majority of cases. I'm just saying that it is common enough that I've experienced it and if I were to take a guess I'd think that in ~20%+ of hospitals FM/psych/others the NP does the same job at the MD.

My question is: Why are docs still being paid more? Will we always get paid more in situations where we do the exact same work?

Part of the problem is that we don't acknowledge this problem. An EM resident once told me that doing a 4 year EM residency, instead of 3yr, was called the "300k mistake" because you could have made 300k more if you did the 3 year. I hope that being a doc instead of an NP doesn't become the 5+ years/200k+ debt/thousands in lost income mistake, if they start handing out attending level paychecks to NPs.

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[deleted245139]

40 patients on the ward, midlevel sees 20. The physician sees ALL of them. They eat they eat the liability. That's why.

 

[Psai]

I don't know what you guys do but the doctor see more complicated patients. For example in the ED, it's not the midlevel that's seeing the MIs and strokes. What do you mean by doing the exact same work? Do you mean talking to a patient and writing a note? There's a lot more to being a doctor than just that. The thought process is what's the most important, having a broad differential and being able to narrow it down with the proper questions and diagnostic testing is our role. Anyone can do a basic h&p, run a bunch of basic labs and scan a patient. Physicians are also more efficient and see more patients as well as providing oversight for the midlevels. The amount of oversight does vary depending on how the facility works, whether someone sees a patient briefly or just signs charts. Either way, the final liability resides on the physician no matter what the midlevel does

 

[deleted407021]

@Psai , not certain how much you know about nurse training, but are physicians uniquely trained to make differential diagnoses? Do you know if that's a major point of distinction between MD/DOs and NPs or PAs?

 

[doggydog]

.

 

[DrBowtie]

So my question concerns the salary difference between MD/DOs and mid-levels that each do 99% the same job. I don't want to argue if PAs/NPs should be able to do the same job as some FM, IM, Psych, and sometimes even EM physicians. I think I'd prefer if they were not able to do the same work, but the fact is that there are many facilities where PAs/NPs and MDs/DOs literally just split patients and do the exact same work.

So why is it that physicians at these places still make ~2X the mid-level salary? Is it simply because of liability? I know that in many states, NPs can practice independently, yet they still make ~1/2 the salary...so I don't think it's just liability. Do you think in the future mid-level salaries will rise and physician salaries will fall? I refuse to believe that hospital admins are paying docs more, for the same work, simply out of the kindness of their hearts.

Disclaimer: I agree that physicians have wayyy more training. Still the fact is that there are MANY places where an FM doc and PA just split the pts.

Using salary is not the way to think about things since that may not be how both are paid. For example, the mid level may be hired for a flat salary while the physician may be strictly RVU eat what you kill. If the mid level generates more RVUs than they are paid on salary, the employer is getting the excess. That may be the partners in a practice group or the hospital themselves.

 

[Rekt]

So my question concerns the salary difference between MD/DOs and mid-levels that each do 99% the same job. I don't want to argue if PAs/NPs should be able to do the same job as some FM, IM, Psych, and sometimes even EM physicians. I think I'd prefer if they were not able to do the same work, but the fact is that there are many facilities where PAs/NPs and MDs/DOs literally just split patients and do the exact same work.

So why is it that physicians at these places still make ~2X the mid-level salary? Is it simply because of liability? I know that in many states, NPs can practice independently, yet they still make ~1/2 the salary...so I don't think it's just liability. Do you think in the future mid-level salaries will rise and physician salaries will fall? I refuse to believe that hospital admins are paying docs more, for the same work, simply out of the kindness of their hearts.

Disclaimer: I agree that physicians have wayyy more training. Still the fact is that there are MANY places where an FM doc and PA just split the pts.

You're argument is completely invalidated with just this point. Surprised you're a medical student spouting this kind of nonsense. Hell, even if it was "99%" of the same job (spoiler alert: it's not), it's that 1/100 patient that can cost hundreds of thousands to millions of dollars if mistakenly handled.

 

[Deja_Entendu]

Level of intelligence.

Knowledge and intelligence are not synonymous terms.

 

[doggydog]

.

 

[ZPakEffect]

So my question concerns the salary difference between MD/DOs and mid-levels that each do 99% the same job. I don't want to argue if PAs/NPs should be able to do the same job as some FM, IM, Psych, and sometimes even EM physicians. I think I'd prefer if they were not able to do the same work, but the fact is that there are many facilities where PAs/NPs and MDs/DOs literally just split patients and do the exact same work.

So why is it that physicians at these places still make ~2X the mid-level salary? Is it simply because of liability? I know that in many states, NPs can practice independently, yet they still make ~1/2 the salary...so I don't think it's just liability. Do you think in the future mid-level salaries will rise and physician salaries will fall? I refuse to believe that hospital admins are paying docs more, for the same work, simply out of the kindness of their hearts.

Disclaimer: I agree that physicians have wayyy more training. Still the fact is that there are MANY places where an FM doc and PA just split the pts.

Why do some NFL players make only several hundred thousand dollars a year while others make tens of millions a year playing the exact same positions?

 

[Merely]

Knowledge and intelligence are not synonymous terms.

It's both.

 

[atomi]

So my question concerns the salary difference between MD/DOs and mid-levels that each do 99% the same job.

Your confusion about why MDs make more than PAs is rooted in this singularly held ridiculously false belief.

 

[Psai]

@Psai , not certain how much you know about nurse training, but are physicians uniquely trained to make differential diagnoses? Do you know if that's a major point of distinction between MD/DOs and NPs or PAs?

Anyone can make a differential diagnosis. But there's a big difference in general knowledge base and understanding of the function of other specialties. The way that the differentials are constructed and eliminated are not the same. Physicians and PAs are less prone to pattern recognition and algorithmic ways of approaching a problem as a result of their education. Also their education is focused on medicine without many fluff courses or group projects about "leadership" that you see in np programs. But PAs have much less education than a graduating medical student. Do you really think a 4th year medical student can compare to an attending physician? Of course the mid levels can get better with experience but that experience doesn't even come close to a structured, rigorous residency program. Working as a secretary in the icu for ten years doesn't make you an icu doc

 

[emergentmd]

EM here.

Op has to be either joking or very ignorant when it comes to medicine or any field for that matter.

EM docs make 3+X more than Midlevels and I think we are relatively underpaid.

Please don't equate the jobs as similar as it shows your ignorance when it comes to the medical field.

You throw me in a midlevel role in the ED and I can see twice as many patients. Throw a Midlevel into my role and they will crap in their pants after the 5th pt.

 

[OnePunchBiopsy]

This is from an older thread somewhere in the bowels of SDN, but it has always stuck with me and I find it relevant.

"PA school and medical school are both sprints, at a 6 minute per mile pace, run through the same neighborhood, from the same starting point to the same finish line. It's just that the PA sprint is 2 miles, and the MD/DO sprint is 4 miles. By necessity, the PA students have to keep to the main roads to reach the finish line in only 2 miles. Med students are expected to take every side street and cul-de-sac available in their journey.

At the end, both may know how to navigate the neighborhood, know which streets cross where, and have a good grasp on the demographics of the area. But only the med students will be able to tell you how many cars, what type, and what color sit in every driveway of every house on every street in the entire area. In casual conversation, or even observing them work, you might get the impression that both learned pretty much the same thing from their races. But probe deeper, and you'll find that only one knows that the guy in 2034 on Rainbow Circle prefers charcoal to gas, and that his neighbor's wife is hot."

Keep in mind though, this quote just mentions medical school. Residency is a whole other beast.

So I believe MD's/DO's are paid more based on knowledge, total hours of clinical training under their belts (experience), and let's not forget that the buck stops with them; they are the ones who sign the bottom line and have the lawyers come after them.

 

[W19]

The militants CRNA are already asking 'equal pay for equal work'... But what they don't understand is that: if they have to pay CRNA the same salary with anesthesiologists, why hire them when you can get an anesthesiologist for the same price.

http://allnurses.com/certified-registered-nurse/does-it-bother-599671.html

 

[IslandStyle808]

The militants CRNA are already asking 'equal pay for equal work'... But what they don't understand is that: if they have to pay CRNA the same salary with anesthesiologists, why hire them when you can get an anesthesiologist for the same price.

http://allnurses.com/certified-registered-nurse/does-it-bother-599671.html

It's like they forgot why the CRNA pathway was created in the first place. And it's not to create a person who is on equal ground as an Anesthesiologist in less time.

 

[Law2Doc]

Bear in mind that doing a similar set of tasks can be worth a very different amount when done by people with differing amounts of training. I'll give an example: Which is worth more, a house I and my colleagues build ourselves or a house put together by a group of master carpenters? Both are houses, but I sure wouldn't pay top dollar for the one built with my training level. So too the mastery isn't there for mid levels who have less schooling or training under their belt. It's not "equal work" in that respect. And so they earn about a third and convey about that percent value. And in this day of absurd healthcare costs, and trying to give everyone access to at least a little healthcare, that's what is affordable. Mid levels have a role in the current economic climate but it's pretty important that we make sure the public realizes that not all white coats represent the same level of care.

 

[Mad Jack]

@Psai , not certain how much you know about nurse training, but are physicians uniquely trained to make differential diagnoses? Do you know if that's a major point of distinction between MD/DOs and NPs or PAs?

You can't do a differential containing something you didn't learn properly. The level of knowledge required for a good differential simply isn't covered in nursing school, not by a long shot. It's like we're fully trained mechanics and they're some kid at Jiffy Lube- sure, we can both change a car's oil just fine, but only one of us is going to be properly trained enough to actually sort out a complex engine issue.

 

[chipwhitley]

You can't do a differential containing something you didn't learn properly. The level of knowledge required for a good differential simply isn't covered in nursing school, not by a long shot. It's like we're fully trained mechanics and they're some kid at Jiffy Lube- sure, we can both change a car's oil just fine, but only one of us is going to be properly trained enough to actually sort out a complex engine issue.

Would you admit this in public? Because most doctors I've seen only talk about how smart and capable NPs are. And as far as regulators are concerned, they do exactly the same job, which is why they have independent practice rights in many states and in some states it's illegal for insurance companies to pay them a different fee for their services than physicians. It's time for doctors to grow a spine and start talking outside of an anonymous forum.

 

[chipwhitley]

Mid levels have a role in the current economic climate but it's pretty important that we make sure the public realizes that not all white coats represent the same level of care.

And yet we do absolutely nothing to ensure that this happens. Midlevel organizations try their best to equate themselves with physicians through every means possible including ads in print and online and numerous articles and social media posts. Where are the ads from physician organizations clarifying the difference in training and expertise that we have? How many physicians take the time to educate their patients about the differences between physicians and midlevels? I've seen maybe one or two articles written by a physician about midlevels at max, compared to midlevels hammering in their equivalency on a regular basis in every news outlet. Even our own schools are teaching us that "we're equal". We are all talk, no action.

 

[akwho]

I have a dear friend about to start nursing school, who keeps telling me to hire her as my anesthesiologist (CRNA) when I'm out in practice, saying "I do the same thing they do, but cheaper." As the surgeon the only thing I care about is the safety, health and well-being of my patients, and quality anesthesia is a huge component of surgical safety. I could care less about the cost of the provider, quality is the first and only important metric. Having another MD present is also useful from a liability standpoint, as I am not the expert in anesthesia. Here is an example of where a CRNA intubated an esophagus, and the MD ophthalmologist got sued for being "captain of the ship."
http://www.omic.com/co-defendant-crna-denies-responsibility-for-failed-resuscitation/
http://www.omic.com/co-defendant-crna-denies-responsibility-for-failed-resuscitation/

 

[Psai]

I have a dear friend about to start nursing school, who keeps telling me to hire her as my anesthesiologist (CRNA) when I'm out in practice, saying "I do the same thing they do, but cheaper." As the surgeon the only thing I care about is the safety, health and well-being of my patients, and quality anesthesia is a huge component of surgical safety. I could care less about the cost of the provider, quality is the first and only important metric. Having another MD present is also useful from a liability standpoint, as I am not the expert in anesthesia. Here is an example of where a CRNA intubated an esophagus, and the MD ophthalmologist got sued for being "captain of the ship."
http://www.omic.com/co-defendant-crna-denies-responsibility-for-failed-resuscitation/

They are not an anesthesiologist

 

[W19]

Would you admit this in public? Because most doctors I've seen only talk about how smart and capable NPs are. And as far as regulators are concerned, they do exactly the same job, which is why they have independent practice rights in many states and in some states it's illegal for insurance companies to pay them a different fee for their services than physicians. It's time for doctors to grow a spine and start talking outside of an anonymous forum.

Physicians are spineless!

 

[Montisumo]

You can't do a differential containing something you didn't learn properly. The level of knowledge required for a good differential simply isn't covered in nursing school, not by a long shot. It's like we're fully trained mechanics and they're some kid at Jiffy Lube- sure, we can both change a car's oil just fine, but only one of us is going to be properly trained enough to actually sort out a complex engine issue.

sort out a complex engine issue. You mean be able to patch it up temporarily until the next engine issue arises.

 

[Mad Jack]

sort out a complex engine issue. You mean be able to patch it up temporarily until the next engine issue arises.

Depending on the problem, you mught be able to fix it. A midlevel might not even know where to start.